Management of Subacute Cough

Initial Assessment

The American College of Chest Physicians recommends performing a focused history to identify key factors, including ACE inhibitor use, smoking status, and signs of serious systemic disease, in patients with subacute cough 2
The American College of Chest Physicians suggests classifying the cough duration to guide the diagnostic approach, with subacute cough defined as lasting 3-8 weeks 4
Determine if the cough is postinfectious or non-infectious in origin, as this will guide the treatment approach 1, 2
Assess for signs of respiratory distress, including increased respiratory rate, intercostal retractions, or cyanosis, in patients with subacute cough 4

The American College of Chest Physicians recommends obtaining a chest radiograph if pneumonia is suspected based on clinical findings, such as tachypnea, abnormal lung findings, or hypoxemia, in patients with subacute cough 4, 5
Consider discontinuing ACE inhibitors if the patient is taking them, as they may be contributing to the cough 2, 5
Counsel and assist with smoking cessation if applicable, as smoking can exacerbate cough 2, 3

If asthma is suspected and spirometry doesn't show reversible airflow obstruction, perform bronchoprovocation challenge (BPC) to confirm the diagnosis 1
If BPC testing is unavailable, consider an empiric trial of anti-asthma therapy, including inhaled bronchodilators and inhaled corticosteroids 1, 2
For suspected non-asthmatic eosinophilic bronchitis (NAEB), perform induced sputum testing for eosinophils if available, or consider an empiric trial of inhaled corticosteroids 1, 3, 5

For upper airway cough syndrome (UACS), the American College of Chest Physicians recommends a first-generation antihistamine/decongestant combination as initial treatment 1, 2, 5
For asthma or bronchial hyperresponsiveness, use inhaled bronchodilators and inhaled corticosteroids as initial treatment 5
For NAEB, use inhaled corticosteroids as initial treatment 5

Don't rely solely on cough characteristics for diagnosis, as they have limited diagnostic value, and instead use a systematic approach to diagnose and treat subacute cough 5
Avoid using antibiotics for viral causes of subacute cough, and instead use targeted therapy based on the underlying cause 5
If cough persists despite appropriate treatment, consider high-resolution CT scan and bronchoscopic evaluation for uncommon causes, such as pertussis or other infections 2, 3, 5